SRC-JBJ H.B. 2382 77(R)   BILL ANALYSIS


Senate Research Center   H.B. 2382
By: Thompson (Wentworth)
Business & Commerce
5/10/2001
Engrossed


DIGEST AND PURPOSE 

Under the Texas Administrative Code, an insurer who covers all other
prescriptions is prohibited from denying coverage of oral contraceptives.
Oral contraceptives, however, are not the only prescription contraceptives.
Some consumers would rather use other contraceptive devices, which may not
be covered by the consumer's health benefit plan.  H.B. 2382 prohibits a
health benefit plan provider from using a different method of coverage for
contraceptive drugs and devices than used for other prescription drugs.  

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a
state officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Chapter 21E, Insurance Code, by adding Article 21.52L,
as follows: 

Art. 21.52L.  HEALTH BENEFIT PLAN COVERAGE FOR PRESCRIPTION CONTRACEPTIVE
DRUGS AND DEVICES AND RELATED SERVICES 

Sec. 1.  GENERAL DEFINITIONS. Defines "enrollee" and "outpatient
contraceptive service." 

 Sec. 2.  DEFINITION OF HEALTH BENEFIT PLAN.  Defines "health benefit plan."

Sec. 3.  PROHIBITED EXCLUSION OR LIMITATION.  (a)  Prohibits a health
benefit plan that provides benefits for prescription drugs or devices from
excluding or limiting benefits to enrollees for a prescription
contraceptive drug or device approved by the United States Food and Drug
Administration or an outpatient contraceptive service. 

(b)  Provides that this section does not prohibit a limitation that applies
to all prescription drugs or devices or all services for which benefits are
provided under a health benefit plan. 

(c)  Provides that this section does not provide coverage for
abortifacients or any other drug or device that terminates a pregnancy. 

Sec. 4.  PROHIBITED COST-SHARING PROVISIONS.  (a)  Prohibits a health
benefit plan from imposing any deductible, copayment, coinsurance, or other
cost-sharing provision applicable to benefits for prescription
contraceptive drugs or devices unless the amount of the required
cost-sharing does not exceed the amount of the required cost-sharing
applicable to benefits for other prescription drugs or devices under the
plan. 

(b)  Prohibits a health benefit plan from imposing any deductible,
copayment,  coinsurance, or other cost-sharing provision applicable to
benefits for outpatient contraceptive services unless the amount of the
required cost-sharing does not exceed the amount of the required
cost-sharing applicable to benefits for other outpatient services under the
plan. 

Sec. 5.  PROHIBITED WAITING PERIOD.  (a)  Prohibits a health benefit plan
from imposing any waiting period applicable to benefits for prescription
contraceptive drugs or devices unless the waiting period is not longer than
any waiting period applicable to benefits for other prescription drugs or
devices under the plan. 

(b)  Prohibits a health benefit plan from imposing any waiting period
applicable to benefits for outpatient contraceptive services unless the
waiting period is not longer than any waiting period applicable to benefits
for other outpatient services under the plan. 
 
Sec. 6.  PROHIBITED CONDUCT.  Sets forth certain prohibitions regarding the
issuer of a health benefit plan. 
 
Sec. 7.  EXEMPTION.  (a)  Provides that this article does not require a
health benefit plan that is issued by an entity associated with a religious
organization or any physician or health care provider providing medical or
health care services under the health benefit plan to offer, recommend,
offer advice concerning, pay for, provide, assist in, perform, arrange, or
participate in providing or performing a medical or health care service
that violates the religious convictions of the organization, except if the
prescription contraceptive coverage is necessary to preserve the life or
health of the insured individual. 

(b)  Requires the issuer of a health benefit plan that limits or excludes
coverage for medical or health care services under this section to state
the limitation or exclusion in the coverage document, the plan's statement
of benefits, brochures, and other informational materials for the health
benefit plan. 
 
Sec. 8.  ENFORCEMENT.  Provides that the issuer of a health benefit plan
that violates this article is subject to the enforcement provisions of
Subtitle B, Title 2, of this code. 
 
SECTION 2.  Effective date: September 1, 2001.  Provides that this Act
applies only to a health benefit plan that is delivered, issued for
delivery, or renewed on or after January 1, 2002.  Provides that a plan
that is delivered, issued for delivery, or renewed before January 1, 2002,
is governed by the law as it existed immediately before the effective date
of this Act, and that law is continued in effect for that purpose.